Strep throat is a bacterial infection caused by Group A Streptococcus (GAS) that primarily affects the throat and tonsils. Although most common in school-aged children (ages five to fifteen), an 18-month-old child can still contract it. Since the infection is much less common in toddlers under the age of three, parents should be aware of the possibility and the signs that may indicate its presence.
The Reality of Strep in Toddlers
Strep throat is rare in children under three years old; one study showed that only about 7.4% of one-year-old patients tested for the bacteria were positive. This lower prevalence is partly due to limited exposure, as many toddlers have not yet entered group settings like daycare or preschool where the highly contagious bacteria easily spreads.
Physiologically, the immune system of a very young child is still developing, and the body’s reaction to the bacteria differs from that of an older child. When 18-month-olds contract GAS, they often present with milder symptoms that are less focused on the throat compared to the classic presentation in older children. Young children can sometimes carry the bacteria in their throat without showing any symptoms, a state known as being a carrier.
Recognizing Atypical Symptoms
The classic symptom of a severe, sudden sore throat is often absent in an 18-month-old, since they lack the verbal skills to complain about throat pain. Instead, the infection manifests with non-specific symptoms that can easily be mistaken for a common cold or a viral illness. A persistent, thick nasal discharge or a prolonged runny nose is a common sign of Strep in this age group, which is rarely seen in older children with the infection.
Caregivers should watch for general signs of distress, such as extreme fussiness, irritability, and a refusal to eat or drink. Gastrointestinal symptoms are also prominent in toddlers, including vomiting, nausea, and abdominal pain. A high fever is frequently present, and the child may have swollen and tender lymph nodes in the neck.
A sandpaper-like red rash on the body indicates scarlet fever, a complication caused by the toxins produced by the GAS bacteria that requires immediate medical attention.
Diagnosis and Testing Methods
Diagnosing Strep throat in a non-verbal 18-month-old relies heavily on the pediatrician’s assessment of these atypical symptoms and the child’s history of exposure. If a doctor suspects Strep, a diagnostic test is necessary to confirm the presence of the Group A Streptococcus bacteria. The procedure involves gently taking a sample from the back of the throat and tonsils using a sterile swab, which can be challenging to perform on a resistant toddler.
The first test performed is the Rapid Strep Test (RST), which can provide results within minutes. However, the RST is not perfectly sensitive and can sometimes produce a false-negative result. For children in this age group, a negative RST is often followed up with a throat culture. A throat culture is more accurate and involves sending the swab sample to a lab to allow any bacteria to grow, with results typically available within 24 to 48 hours.
Treatment and Addressing Potential Risks
If the diagnosis is confirmed, the standard treatment for Strep throat is a course of oral antibiotics, such as amoxicillin. Antibiotic treatment is started quickly to reduce the duration of symptoms and prevent the spread of the infection to others. The primary reason for treatment is to prevent serious secondary complications that can arise from an immune response to the untreated bacteria.
It is necessary to complete the entire course of antibiotics as prescribed, even if the child starts feeling better after a few days, to ensure the full eradication of the bacteria. Untreated Strep can lead to complications such as acute rheumatic fever, an inflammatory condition that can permanently damage the heart valves and joints. Other serious complications include post-streptococcal glomerulonephritis, which affects the kidneys, and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS), involving a sudden onset of behavioral or tic disorders following the infection.